Topeka — A doctor provided only the minimum care required when she referred patients as young as 10-years-old to Dr. George Tiller’s clinic for late-term abortions, an attorney for Kansas’ medical board said at a disciplinary hearing Monday.

Dr. Ann Kristin Neuhaus is accused of negligence in conducting mental health exams, and the attorney for the State Board of Healing Arts attempted to bolster the case against her by calling a Georgetown University professor as an expert on psychiatric examinations. The professor reviewed Neuhaus’ medical records and raised questions about Neuhaus’ use of a computer program, “PsychManager Lite,” to record exam notes.

A complaint before the State Board of Healing Arts deals with Neuhaus’ care for 11 patients — ages 10 to 18 — all at least 25 weeks pregnant, who received abortions from July to November 2003. Kansas law permits the abortion of a viable fetus starting at the 22nd week of pregnancy only if the woman faces death or “substantial and irreversible” harm to “a major bodily function,” which in 2003 included mental health. Neuhaus diagnosed the young patients seeking abortions with anxiety disorder, acute stress disorder and single-episode major depression

“You have individuals who attempt to get by with the minimum,” board attorney Reese Hays said in an opening statement. “The evidence will show that’s where Dr. Neuhaus falls.”

But Neuhaus’ attorney, Robert Eye, said the evidence will show she more than met accepted standards of care, including conducting face-to-face interviews with each patient. Eye said evidence also will show that not every patient who saw Neuhaus ultimately could obtain an abortion under a Kansas law limiting late-term procedures and requiring a second opinion, though all of the 11 patients covered in the complaint did.

“They were living in a fishbowl,” Eye said in his opening statement, referring to both Neuhaus and Tiller. “They knew they had to be careful.”

Board’s expert

Board attorneys on Monday called Dr. Liza Gold, a clinical professor of psychiatry at the Georgetown’s Medical Center in Washington, as their expert witness. Gold was expected to resume testimony today and go through each patient’s case.

Part of her testimony Monday dealt with Neuhaus’ use of “PsychManager Lite.” Gold said recording notes in the program wasn’t a valid use of the program, which, the professor said, was designed to help physicians sort through symptoms as they worked toward a diagnosis.

But even then, Gold said, the program used a series of yes or no questions, so that using it to compile a report still wouldn’t show an exam “occurred with any amount of depth.” She said such tools typically have been used only in teaching, not in patient care.

“They never became widely used, and they’re not used widely now,” she said.

While the program came from the authors of the latest version of psychiatry’s diagnostic manual, Gold said, even that manual wasn’t meant to be used “like a cookbook.”

Eye planned to call Allen Greiner, a professor at the Kansas University Medical Center in Kansas City, who also serves as health director for Wyandotte County’s health department. Eye argued that what’s important is whether Neuhaus followed standards of care used in Kansas specific to providing abortions.

“This not a cookie-cutter process,” Eye said in his opening statement.

The hearing is expected to take four days, and the board’s hearing officer is likely to take several weeks more to issue an order. The 15-member board will then review the order and decide whether to impose sanctions, which could include revoking Neuhaus’ license. Most board members are physicians.

Ties to Tiller

Tiller was among a few U.S. physicians performing late-term procedures when a man professing strong anti-abortion views shot him to death in May 2009. Two months before, Tiller was acquitted of misdemeanor criminal charges that, in relying on Neuhaus for referrals, he wasn’t getting the independent second medical opinion state law required for many abortions past the 22nd week of pregnancy.

The complaint alleges Neuhaus, from Nortonville, didn’t conduct adequate interviews, take adequate patient histories or do proper examinations, failing repeatedly to follow accepted standards of care.

The allegations before the medical board stem from a complaint filed in 2006 by an official of the anti-abortion group Operation Rescue. Another group, Kansans for Life, also has been pushing the board to discipline Neuhaus at least since 2000 and filed petitions about her with the board in 2008 and 2009.

Neuhaus performed abortions from 1994 to 2001 at a Wichita clinic and operated an abortion clinic in Lawrence from 1997 to 2002. She ended both practices, citing financial problems.

Cases about Neuhaus were before the board in 1999, 2000 and 2001, with some allegations dealing with record-keeping and handling of medications. In the past, she’s had her ability to dispense drugs restricted or temporarily suspended. In 2001, she agreed to modify her clinic’s procedures and allow random inspections of its records over two years.

Neuhaus doesn’t have an active medical practice, but her Kansas license allows her to provide charity care. The board says Neuhaus has asked to return her license to full, active status.

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